Theories of Everything with Curt Jaimungal - Adrian Owen: Awake. Aware. Unable to Move.

Episode Date: August 24, 2026

SPONSORS: - Visit https://mod.com for a free consultation and get 10% off your first order PLUS free shipping with promo code TOE. - I personally subscribe to The Economist. TOE listeners get 35% off the annual subscription. No other podcast has this! https://economist.com/TOE There are three questions people ask about consciousness: what it is, how to explain it, and how to measure it. This episode is entirely the third one. Adrian Owen, professor of cognitive neuroscience at Western University, joins to explain how he detects consciousness in patients thought to be completely unaware — and why he believes thousands have been "hiding in plain sight" for decades. Owen walks through the landmark case that started it all: asking a non-responsive patient to imagine playing tennis, and watching her brain light up like a healthy person's. We discuss the differences between coma, vegetative state, minimally conscious state, and locked-in syndrome, and what recovered patients have reported about their experience — including one man whose memories were sharper than his doctor's. The conversation covers how movies like Taken are used to detect awareness through brain synchronization, why negative results can never prove someone is unconscious, and the ethics of asking a locked-in patient if they want to keep living. This is an in-depth conversation with Adrian Owen. FOLLOW: - Spotify: https://open.spotify.com/show/4gL14b92xAErofYQA7bU4e - Substack: https://curtjaimungal.substack.com/subscribe - Twitter: https://twitter.com/TOEwithCurt - Discord Invite: https://discord.com/invite/kBcnfNVwqs - Crypto: https://nowpayments.io/donation/TOE - PayPal: https://www.paypal.com/donate?hosted_button_id=XUBHNMFXUX5S4 TIMESTAMPS: - 00:00:00 - Trapped Consciousness Detection - 00:05:15 - Total Locked-in Syndrome - 00:10:40 - Wakefulness Without Awareness - 00:15:45 - The fMRI Tennis Test - 00:21:00 - Decoding Neural Intent - 00:26:30 - Mapping the Grey Zone - 00:32:00 - Non-Responsive Patient Lucidity - 00:37:30 - Life-Support Ethical Dilemmas - 00:43:00 - Brain-Computer Interface Futures - 00:48:30 - Hijacking Consciousness via Narrative - 00:54:00 - The Liam Neeson Test - 00:59:30 - Thalamocortical Pathway Disruption - 01:05:00 - Deep Brain Stimulation Potential - 01:10:30 - Anesthetic Awareness Dangers - 01:16:00 - AI and Language Lures - 01:21:30 - IIT Pseudoscience Controversy LINKS MENTIONED: - The Owen Lab: https://owenlab.org/ - Think Before You Think [Book]: https://amazon.com/dp/1324075163?tag=toe08-20 - Into The Gray Zone [Book]: https://amazon.com/dp/1501135201?tag=toe08-20 - Into The Gray Zone [Lecture]: https://youtu.be/01_ECXZK9dA - Detecting Awareness In The Vegetative State [Paper]: https://www.science.org/doi/10.1126/science.1130197 - Cortical Processing In Persistent Vegetative State [Paper]: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)77805-3/abstract - Response To 'Minimally Conscious State Or Cortically Mediated State?' [Paper]: https://academic.oup.com/brain/article/141/4/e26/4838964 - Risk, Diagnostic Error, And The Clinical Science Of Consciousness [Paper]: https://pubmed.ncbi.nlm.nih.gov/25844313/ - A Common Neural Code For Similar Conscious Experiences In Different Individuals [Paper]: https://www.pnas.org/doi/10.1073/pnas.1407007111 - Locked-In Syndrome: https://www.ninds.nih.gov/health-information/disorders/locked-syndrome - CIFAR: https://cifar.ca/research-programs/brain-mind-consciousness/ - Tests For Consciousness In Humans And Beyond [Paper]: https://www.cell.com/trends/cognitive-sciences/fulltext/S1364-6613(24)00010-X - Early Identification Of Recovery Potential After Acute Brain Injury Using Functional Near Infrared Spectroscopy [Paper]: https://link.springer.com/article/10.1007/s12028-026-02605-0 - Consciousness Iceberg [TOE]: https://youtu.be/65yjqIDghEk - Michael Levin & Anil Seth [TOE]: https://youtu.be/_kuwwmFnxGY - Iain McGilchrist [TOE]: https://youtu.be/Q9sBKCd2HD0 - Roman Yampolskiy [TOE]: https://youtu.be/TgFmA-Qwsek - Elan Barenholtz [TOE]: https://youtu.be/A36OumnSrWY - Simon Saunders [TOE]: https://youtu.be/Ihv542rCUns Guests do not pay to appear. #science Learn more about your ad choices. Visit megaphone.fm/adchoices

Two and five Canadians will hear the words, you have cancer. That's why every step and dollar raised matters. On September 19th, join thousands in Toronto for the Princess Margaret Cancer Foundation Walk. Challenge yourself, friends, and family to walk 21 kilometers in support of life-saving research. Together, we can carry the fire and help create a world free from the fear of cancer. Register today at pmcfwalk.ca. I think we're asking completely the wrong question. These people were hiding in plain sight.

It was absolutely terrifying. This is Adrian Owen, professor of cognitive neuroscience at Western University. Today, we talk about the revolutionary method to detect trapped consciousness in patients we previously thought were completely unaware, not able to move or speak. You scanned him. He was aware, conscious throughout. The response I would typically get from my neurological colleagues is,

Well, no, that can't be possible. And I would say, well, how would you know? The whole point is you would never know. On this channel, I. Kurchai Mungle, interview researchers regarding their theories of reality with rigor and technical depth. Today's episode may pave the way for a new dawn of a science of consciousness, something we previously thought was impossible. And it's all thanks to Adrian Owen. So when did you first find someone in there? Oh, that's a great question.

And it depends really on what you mean by in there. I mean, the first time we actually put a behaviorally non-responsive patient into a scanner and looked at what was going on in their brain was 1997. What we did at the time was to show her pictures of faces of her friends and family and the part of her brain that we know processes faces lit up. And so in some senses, that was the first time that we saw anything resembling somebody being in there. But the big question was, was she really in there? Is she having that experience? Or was this just her brain sort of firing off automatically to familiar material from a world that she knew before her injury? Most of this channel, we talk about three aspects of consciousness.

One is how do you define it? Well, what is the definition of consciousness? Number two is what's the explanation of consciousness? And then three is more about measurements. But this latter, third one, is under explored on this channel. you're squarely in that zone. Can you talk about what it's like to measure consciousness? Yeah, I mean, you're absolutely right. I mean, for me, it's not really about theories of consciousness or even understanding necessarily what consciousness is. The position I come from is trying to work out whether another being's inner world, their subjective experience, if you like, is like mine or not like mine.

that's really all I need to know. I'm faced with patients every day who are critically ill. They're non-responsive. They may have had some kind of brain injury, a stroke or a traumatic brain injury, or even a cardiac arrest that has resulted in a lack of oxygen to the brain. And they're non-responsive. They're just lying there in their beds and you ask them to blink an eye. They won't do it.

If you ask them to squeeze your hand, they won't do it. And the question is, well, could they actually be inside? Could they be consciously intact, if you like, aware of who they are, where they are and the predicament that they're in? Can we get to that without resorting to behavior? So you're absolutely right. Measurement is really, for me, is the most important thing. And it's really about measuring whether somebody's subjective experience is like mine or not. Now, it sounds quite terrifying to be trapped.

So what is that experience like? Well, we know from several patients who have recovered over the years and have reported back to us what it was like. I mean, one gentleman who springs to mind immediately, a Canadian young man about 19 years old, we put through the mill, we scanned him, we had him do all sorts of things. and turns out that, you know, he was aware, conscious throughout. And he, about nine months after we scanned him, went on to actually make a very good recovery. He took himself back to college eventually. And he described what it was like.

And, I mean, yes, you're right. I mean, he said it was absolutely terrifying. The thing that kept him going was the knowledge that he thought he was always going to come out of this. He was fairly confident that he was going to recover. But the idea, I mean, he remarked on several occasions about how odd it was to have conversations being had about him in his presence as though he were not there when in fact he was completely conscious and following the whole narrative of the conversation. And this actually, I mean, this echoes back to Kate, the 1997 patient who also went on to make a recovery and also reported various. aspects of how it was to be in that situation where people don't know that you're in there, but actually you have some level of awareness. And for her, she felt, I mean, she,

I've written about this a few times. I mean, she said, the day that you scanned me, I went from being a thing to a person. So for her, it actually restored her personhood. And exploring that further, what she means by that is that people started to treat her as a person, not as an object, once they had the sense that there was something left of the original Kate. What was it about Kate that made you see her as a person or a potential person and not a thing then? I guess, well, I originally trained in psychology back in the UK in the late 80s. So I've always been really interested in people. I'm much more interested in why people do what they do and why they think what they think.

and make the decisions that they make. And so I guess from my perspective, I've always thought of these patients as people, and I've always assumed there must be some more going on than we can possibly observe from the outside. I mean, I can tell you exactly what my thinking processes were. I mean, many years ago when I started to think about this, I realized, well, there are patients in the world,

many patients who have a syndrome known as locked-in syndrome. And this is a condition that some people will have heard about. It's where you're basically entirely conscious, but you're mostly paralyzed, mostly immobile. Typically, these patients can blink an eye or move an eye, and some of them make themselves known in that way, and have even had conversations by sort of blinking their way through, you know, with various assisted devices. Now, that's the locked-in syndrome. We know it exists. we've only existed for many years, it always sort of seemed obvious to me that there must be

another syndrome called, I mean, it doesn't have a name, but maybe the total locked-in syndrome, where even your ability to move your eyes or blink your eyes is gone, yet you're cognitively or consciously perfectly intact. I mean, why would it be that all of that stuff goes at once? And we know a lot about the sort of different brain damage involved in producing these syndromes. And with the locked-in syndrome, it's damaged to a particular part of the brain stem means that consciousness is preserved, but the ability to move is largely impaired, except for eyes or eye movements. Why would it be that a slightly different type of damage would

knock out eye movements and consciousness? It just didn't ever make any sense to me. So I kind of went through my scientific life, claiming that these people must exist. We just needed to find a way of accessing them. Quick question about that. Did your colleagues think differently? Yes, they did. Many of them did. I mean, the response I would typically get from my neurological colleagues is, well, no, that can't be possible.

I've never seen a patient like that. And I would say, well, how would you know? Right. The whole point, the whole point is you would never know. I said, no, I just would know. I would know if somebody was conscious. And, I mean, it turns out 20 years later when several thousand patients have been revealed in this way that they wouldn't have known. And in fact, these people were hiding in plain side, if you like.

They were right there. And this has always been the case. It's just that until 2006, we really didn't have a way of absolutely determining. that they were conscious. You know what? I think it's super useful at this point. There was a diagram from one of your talks where you distinguish a coma from a vegetative state,

from being in a so-and-so state, and I don't know if you have access to that. I mean, I can bring it up. I do. Yeah, yeah. Perfect. Talk the audience through this so that they understand the differences

of what we're talking about and not talking about at different stages. Okay. So, yeah, this is a very important point because conditions like coma and Vegetative State and Lottin syndrome, even brain deaths, are often confused. And they are completely different conditions. I mean, typically, if you have a serious brain injury,

the first thing that is going to happen to you is you'll be in a coma. And when you're in a coma, you require typically life support. You'll be in an intensive care unit. You'll have apparatus that helps you breathe, keeps your heart beating, keeps you alive, essentially. Comber patients have eyes closed. They kind of look like they're asleep or deeply anesthetized. Now, after coma, coma might last hours, days or sometimes weeks.

A patient may go in sort of two different directions. They may pass on, die, or they may emerge and emerge to a so-called vegetative state. And this is a condition in which patients actually wake up. They have open eyes. they'll often have so-called roving eye movements. They'll sort of look around the room, but they won't look at anything in particular. So if there's a clock on the wall, they won't stare at the clock.

They'll just sort of aimlessly look around. But they'll grunt and groan, they'll yawn, they'll cough and splutter. And in many ways, this is the most mysterious condition because they are somewhat animate, it's very hard to get away from the idea that they're aware and they're conscious because they, I mean, they don't get up and walk around, but at least they move and they have sleeping and waking cycles and these sorts of things. So that's the condition that I've focused most of my work on, and that's the really difficult one.

Of course, then you have, you know, brain death. Brain death is brain death. We may as well call it death. You don't recover from brain death. When you read in a newspaper, so-and-so recovered from brain death, what it means is they were misdiagnosed to start with. You can't... Interesting. You can't come back. from a brain death. You can come back from a vegetative state and you can certainly come back from coma. And then you have the locked in syndrome which I've already explained, which is kind of similar. Again, it's caused by a certain kind of brain damage that tends to render you immobile, non-responsive, except perhaps for your eyes or your eyelids, but nevertheless

you retain consciousness. Yes, you make a distinction between awareness and awakeness or wakefulness, that you can be awake but not aware. And can you be aware but not awake? That's a very interesting question. I mean, the two things in various ways are both dissociable. Yeah, I mean, you can in the sense that, let's say, you know, studies of sleep, for example, involve, you know, you can learn things while you are asleep, that you are not awake, but you are in some senses aware.

You're not aware in the same sense that you and I are right now of having complete access to our entire subjective experience, but some levels of awareness are required for you to process that information. The other way around is much more common, and in fact the vegetative state is often referred to as wakefulness without awareness, because the patients are awake, they have sleeping and waking cycles, but there's no evidence that they have any awareness of the world around them. To many people, like to Kate, you changing her from a thing to a person, you're a hero. Like you've revolutionized the measurement of consciousness and found that some people who we thought of as not conscious are indeed conscious.

But at the same time, it's quite terrifying. I mean, we want to know. We don't want to misdiagnose. It's actually worse to misdiagnose someone as being not conscious when they indeed are. But how has this changed you? How do you view death? How do you view these states? How does this change your life?

That's a great question. I mean, lots of people say to me, I mean, here's just some example to give you something to think about. A lot of people say, well, you must have an advanced directive. You see these patients all the time. You see what they go through. You see decisions that are made about them. People imagine I must have carefully written out somewhere in my will exactly what I want to happen to me should I ever end up in this situation, a so-called advanced directive. And actually, quite the opposite is true. I'm terrified of writing an advance. directive because what I now have learned is that you can never know how you're going to feel when you're in that situation unless you're actually in that situation. So, I mean, there's very good evidence that, for example, most of us when asked, well, what would you want to do if you end up looking like this person in the ICU bed, most of us will say, pull the plug, I never want to be like that. But actually, if you talk to people who have ended up, for example, in the locked in syndrome when they're about as close as you can get to that situation. Very few of them say they want to die. So, and certainly that's the case in our hands too, the patients that we've been able to

communicate with who are entirely non-responsive, but we communicate with them by getting them to change their patterns of brain activity to indicate yes and no to questions. These patients don't give the impression that they want to die. So, yeah, so for me, the only thing worse than I can imagine worse than ending up in a condition like a vegetative state is to be in that condition and to have written an advance directive that somebody acts on when I've changed my mind. Yeah, so I think that's what is really, this work has really taught me that you can never really know

what it's like to be in a situation until you're actually in that situation. Why can't your advanced directive just say communicate with me about so-and-so? Yeah. Well, yes, it could do. I mean, I guess if I had one, it would say, put me into an MRI scanner and ask me what I want to happen. Yeah, whether that one would hope, given the people I work with and how closely I work in this situation, this would happen anyway. But, uh... Okay, now, I have the advantage of going through your work and your book, the link to which will be on screen and in the description. But the viewers may be listening and thinking, okay, wait, just a moment. there are these people who can't be communicated with, they can't move, but yet we're saying we're communicating with them. So walk us through, there's a patient, what are you doing? So you test for this and that, and then we used to conclude so-and-so, but now we think, walk us

through that. Okay, let's go back in time, right? So it's in 1997. I was working at University of Cambridge. I had a lot of experience of brain imaging. No experience at all of conditions like the vegetative state or the, you know, the coma, any of these conditions. And along came this patient, Kate. And because I was the sort of local guy with the imaging experience, somebody said, well, you put in the scan and see what's going on in the brain. At that point, you know, historically, it's a very interesting time. This was just not something that anybody did because it was just assumed these patients had no future. There would be nothing. You'd see nothing in their brain. And, you know, we showed a pictures of faces and friends and family.

and her brain lit up and so on. We got very excited about it at the time. But the question was, well, does that mean she is conscious or is this some kind of automatic process going on in her brain? And it was actually almost 10 years later that we solved that problem. And we solved the problem by not stimulating her, not doing something that the brain could automatically just fire back a response. Like speech, for example. You know, I'm talking to you right now. People are listening to this right now. You can't choose to not understand me. At least if you understand spoken English, it's not a choice you make. Your brain is automatically processing that. And one can, I mean, I can tell you that if I were to anesthetize you or put you to sleep, your brain will still process information. It will still go through the motions of decoding spoken language, even though you're not having any phenomenological experience of that actually occurring.

And where we landed in 2006 was on getting somebody to imagine a scenario that we knew would generate activity in a particular part of the brain. So I won't go into great detail about how we arrived at this idea, but suffice it to say, we asked a patient to imagine she was playing a game of tennis. And that's simply because we wanted to get her to activate the areas of her brain that we know are involved in coordinating big sweeping upper body movements, partly because it's really obvious when somebody's doing that. We've done it in thousands and thousands of healthy people. If you put them in a scan and say, imagine playing tennis, a part of the brain known as the

pre-motor cortex will immediately respond. And that's the bit of your brain that's involved in setting up sequences of movements. It's not the part that actually does the moving, but it sets up sequences of movements. And that occurs whether you're going to do the movement or not. to be just thinking about the movement, it still occurs. Now, the beauty of this idea is that it's not something that happens automatically. So, yeah, sure, you may get a fleeting moment where you can't help but think about tennis if I say imagine playing tennis. But to get through this MRI task, the patient had to continue to do it for 30 seconds without any prompting. We would just say, start imagining playing tennis now.

and we would look for what part of her brain lit up and stayed alight for 30 seconds until we said, okay, now relax, an activity would disappear. So it wasn't something that could have sort of automatically occurred, and we did a lot of other studies around that time to prove that this was not something that could occur unless she wanted it to happen. And as she decided, for whatever reason, I'm going to do what Adrian Owen is asking me to do and imagine playing a game of tennis. that's how we really got to grips with, you know, working out that somebody who was actually conscious. I mean, I could break it down for you. Please. You know, it's not just thinking about playing tennis.

If I say to you, for the next 30 seconds, imagine playing tennis. You've got to hold that in your memory, that instruction. You've got to understand the instruction. You've got to understand what I mean by imagine playing tennis. You've got to draw on a long-term memory of what tennis is. If you don't know, if you've never played tennis, it's not going to work. you need to pay attention to what you're doing. Stay on task.

Lots of very high-level cognitive processes are required for you to imagine playing tennis for 30 seconds and then stop doing it for 30 seconds. It's not just a simple process. So just by the fact that somebody can do it, you can deduce that all these other aspects of consciousness are intact. And that's how we did it originally. It turns out it worked beautiful and it worked in the first patient we tried it in which I think also added to the sort of excitement

at the time. From there it's relatively, it's not rocket science to turn that into some way of communicating with people and the way we do it these days is put you in the scanner and I say, okay, Kurt, if your name is Brian, imagine playing tennis, right?

Right. And hopefully nothing will happen because your name is not Brian. And so you don't imagine playing tennis. And then I'll say, well, if your name is Kurt, imagine playing tennis. And activity will appear in your premodic cortex because your name is Kurt. So to say yes, you're imagining playing tennis. So it's a sort of simple yes, no type of idea. But you can ask all sorts of questions like that.

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And the difference between play tennis in your mind for 30 seconds and then something like, hey, imagine a golden book. Or I think the stereotypical is the pink elephant, something like that, which happens unconsciously, reflexively for most people. The difference is that, that one happens reflexively, but imagining playing tennis doesn't, or at least not for 30 seconds? Exactly. I mean, it does certainly happen. I mean, I'm sure at the very moment I say tennis sort of, I don't know what jumps into your head, Wimbledon, strawberries, whoever the latest, greatest tennis player is. But that will be a momentary thing. You're not going to sit and think about waving your, I mean, it's not just tennis. You've actually got to think about waving your arms around. If you sit and think about tennis for 30

seconds, that's not going to activate your pre-motor cortex either. You have to think about you playing a game of tennis. And you actually take it? I'm so sorry, are you explaining it to the patients in the same detail that you're explaining it to me? We do, yeah. So, I, uh, I'm, And this is an interesting situation because, of course, at that point, we don't know whether they're conscious or not. So we don't know whether we're talking to somebody that has no experience of being told anything or whether the person understands completely. So it's a bit of a leap of face and we sit down and say, okay, this is going to seem strange. But we're going to ask you to play tense because if you can do that, we will know that you are conscious, because we will

know that you are activating the parts of your brain that are involved in the mental imagery involved in thinking about game of tennis. So yeah, we talk the whole, the patient's through this whole thing because, of course, it would be a bit bizarre not to, I suppose, if you are the patient and you are conscious, that's probably the last thing you would expect somebody to do to put you into a scanner and ask you to play tennis. So it requires explanation, I think, and we get much better results when we explain carefully why we're doing it. So you have a book called Into the Greyzone. I do, yes. What is the Grey Zone? So what I meant by, I mean, the grey zone is, in this context, it's just a term I coined myself.

And I was just trying to convey the idea that for many of these patients, we don't know where they are. We don't know whether their internal life is rather like the internal life of an inanimate object, a table or a chair. They have no internal life at all. or whether their interlif is much the same as you or I, or whether they're somewhere else, somewhere in between the two. Are they conscious some of the time? Are they partly conscious all the time? That's what I think of as the grey zone.

It's really, it was just really reflecting on day one with a patient. You have no idea where they are on that continuum. They could be anywhere from completely, you know, incomplete, oblivion to being entirely conscious and completely aware of who you are and where they are and the predicament they're in. Two and five Canadians will hear the words, you have cancer. That's why every step and dollar raised matters. On September 19th, join thousands in Toronto for the Princess Margaret Cancer Foundation walk.

Challenge yourself, friends, and family to walk 21 kilometers in support of life-saving research. Together, we can carry the five. and help create a world free from the fear of cancer. Register today at pmcf walk.ca.ca. Did the gray zone teach you anything about what it's like to be, gosh, in the black zone or in the white zone? Now, it makes no sense for me to say what it's like to be in the black zone

because by definition, but hopefully you can make sense of that. Of course, yeah. Yeah, I mean, I think it really did help us to work out how to categorize patients in a different way than they're typically categorized. I mean, basically these patients are sort of divided up according to what they can do. You know, if you appear to show no behavior at all, no responsiveness, then often you'll be diagnosed as being in a vegetative state. We now know that that's incorrect, probably 25% of the time. But, but that's where you get pigeonholed.

If you show some signs of having some connection with the outside world, but it's sort of not sufficient for you to be able to communicate or say yes and no, you'll often be diagnosed as a condition I haven't talked about called the minimally conscious state. And that's really a sort of a catch-all term for anybody that's somewhere between vegetative and, I guess, severely disabled or clearly conscious, just suffering some brain damage. So, yes, we typically categorize people according to their behavior. And it turns out, I think what the crazy owner has shown us is that's completely wrong,

because you can be entirely conscious. And by that, I mean, their inner world is exactly like yours and mine. They have thoughts. They have feelings. They have plans. They have emotions. They have memories. they reflect on things.

The patient who recovered and told us a lot about it, I mean, he spent an awful lot of time reflecting on his life and what he was going to do if he didn't get out of this situation and how he was going to move forward and these sorts of things. So, you know, but at the time he was categorised as being in a vegetative state based on his behaviour. But actually, I would now categorise him as being, just like you or I, except he couldn't live.

And this hymn, is it Juan? It's Juan, yeah. Okay, so for this person, I know it varies per person, so that's why I'm going to just pick on Juan for now. Yeah. When they're recollecting, after they've come out of this state, do they have a good memory of it? I mean, sorry, not good as in a positive.

Like, this was a good time in my life. I mean, it's a strong memory. Do they have a strong memory of it? Or is it more like a haze, like they felt delirious, or what? Depends on the patient. but let's focus on one because he's a really, really special and interesting case. And I had a whole chapter about one in my book. So the interesting about Juan is that he, about nine months after we put him sort of through all the tests and everything,

it turned out that he was making a good recovery and we called up his mother and asked how he was doing. And she said, well, why don't you ask him? And this was a bizarre experience. One came to the phone and was speaking and told himself to walk again and clean his teeth and all the things that patients become very reliant on others for. So I immediately said, right, I'm not going to talk to you anymore. I want you to come back to London and we're going to see if you can remember anything about your experience. And the strangest thing about Juan is that his memory was excellent.

It was actually way better than my memory of the events. despite the fact that I'd been there all the time. So we asked him actually really tricky questions. Like, you know, what were the colour of the electrodes that we put on your head to do the EEG, the electroencephalography? And it could as a flash, he said, well, they were blue. And they could have been blue, they could have been red. You know, we have two sets, blue and red.

But blue. I said, do you remember who put you in the scanner? And instead of saying, yes, you know, it was some middle-aged guy. He said, yeah. his name was Steve, he was one of your graduate students and he had a really deep voice. Wow. So he would, and this is all true. Steve was a graduate student in my lab at the time and he does have a, or he did have a very deep voice.

So this is the interesting thing about one that he'd sort of, he'd been observing all these things. And in a way, it made an effort to remember them. And when I interviewed him for the book, I said, well, how do you remember all this stuff? I don't even remember which one of my graduate students scanned you nine months. ago. And he said, well, I had nothing else to do, did I? Um, quick as a flash. I mean, he basically said that, um, he knew he was going to recover. He knew he was in this situation for now and he was going to spend his time, um, observing, processing, remembering everything going on around him. And that's exactly what he did. And, you know, as I say, we, we had to go back and verify this

and, you know, was it Steve. Yes, it was Steve. I know Steve has a deep voice. There were other sort of physical characteristics of some of the start. And, you know, he said, you know, he said, and that he can't possibly have learned this later. He must have observed it on the day, on a day when we thought he was entirely vegetative. Was he also feeling? So you mentioned, look, you can't move your fingers or what have you. Could he feel what was going on to him?

Right. So that's really interesting. And again, I sort of focused a little bit of the book on this because he, again, is the only patient who's really been able to report these things in details. And one of the things he said was that he was scared going into the scanner. And this was sort of fairly early days for us in our scanning. So it is possible that we didn't do everything we could have possibly done to reassure him

and tell him exactly what was going on because he did say, I didn't really know why you were doing this. I cried. And interestingly enough, interesting enough, I mean, we have, we were all sort of, looking at him. He wasn't physically crying at the time. But internally, he felt that he was crying. So he was sufficiently upset or scared that he had this sense of tears and, you know, being upset. So, yes, long answer to your question, yes, they do have feelings. That's an extremely interesting choice of words to say I was crying rather than I was feeling afraid or frightened or something.

something like that, because for me, if I say I'm crying, it's actually the physical production of tears. And I won't say I'm crying if I don't see or feel that. Me too. Yeah. Yeah. I mean, of course, it is possible that there was some sort of disconnect between how he felt emotionally and the access he had to his own sort of bodily functions. I mean, obviously, you know, he couldn't move. A lot of the, you know, a lot of the machinery of his brain that was involved involved in movement and in keeping his brain in touch with his body was damaged. So it is entirely possible that he thought he was crying, as in producing physical tears, but there won't any.

But, you know, who knows? Now, for him, his memory was clear and his experience, would you say that that was also lucid? Oh, 100%. I mean, this is the answer. You know, often people say to me, well, so these patients are in something. kind of, you know, minimally conscious state or some grey zone. And no, I say, no, no, he was exactly like I would be in that situation if you just paralysed me so I couldn't move.

I mean, he's entirely lucid. He told stories about, you know, how he got there. He recognized the room he was in. He recognized the people that did the scans. He remembered the colors of this, that or the other. You know, his memory was quite extraordinary. And you can't explain it in any way other than that he was having a full subjective experience of where he was and what was going on around him. And you ask these people, or someone else asks these people, do you still want to continue on living? And generally speaking, what do they say?

So we haven't got that far. So, well, well, we have got that far. We have got that far, but I need to be a little bit careful about this. So the patient, the first patient that we communicated with, this was a patient who was in Belgium in 2010. And this was a long term, a patient who'd been supposedly in a vegetative state for five years following a road traffic accident. Yes, he could imagine playing tennis when we asked him to do that. He could imagine all sorts of other things that we tried at the time. And we did go ahead and ask him a series of questions like, you know, is your name X? Is it Y? Are you in a hospital?

are you in a supermarket. These were just to verify that he knew who he was and where he was. And then it is true. We did ask him whether he wanted to go on living like this. And the answer, but that's the only time it's happened, to my knowledge. The answer was completely ambiguous. We couldn't decode whether it was a yes or a no. And looking back, I think the reasons for that are pretty obvious. At the time, it wasn't clear what was going on. It was the last question of the day. And I think we concluded, perhaps he was tired. and he can no longer keep generating these sort of mental imagery. But actually, in retrospect now, I think it probably is more to do with the fact that we were only asking yes and no questions.

I mean, if I ask you, Kurt, whether you want to live or die, I doubt your answer is going to be a simple yes or no, especially if you've got a disabling brain injury. Your answer is probably going to be, well, it depends. Are you going to get me out of this situation any time soon? Right, right. It depends. What are my chances of recovery? And we didn't have an it depends option. We just had a yes or a no.

You know, and we've tried this with sort of simulations, with healthy students and things over the years. To try and work out, you know, what might have been going on. I'm pretty convinced that that is probably what was happening. You know, for him there wasn't a straightforward yes and no answer. He was probably sitting thinking, well, I need to understand what's going on for me and what the chances of recovery are. But, sorry, just to add a little bit of context to that,

you have to remember that vegetative patients, you know, are not on life support systems. These patients often go back into the community. They're cared for in family homes or long-term care facilities. Unlike coma patients, in the vegetative case, these are not patients where there's a sort of a plug that you can pull. So there's no sort of easy way to act. on information like, you know, would you like to live or die?

But the coma patients early in the early days after a brain injury, yes, there is. And withdrawal goes on in ICUs around the world, you know, all the time. If it's assumed there's no hope of recovery, and that's an area we're working in right now. But in those patients, we haven't got to the stage of asking anybody whether they want to live or die. We only did it in a chronic patient. And, you know, honestly, there wouldn't have been anything we could have done about it at the time. because it's not as easy as pulling a plug on these people. Yeah, yesterday I was at a restaurant and they asked me if I wanted steak fritz.

I couldn't give a yes or no at that point for steak freets. So I imagine you could also ask yes or no. Could you say three options say the answer is going to be yes or no or let me expand further even though they can't quite expand? But it's a third option. Could you do something like that? It is. unfortunately it's a case of diminishing returns though

the more options you have and we do have other options the harder it gets and that's because there aren't very many things that I can get you to imagine that will reliably produce activity in a part of the brain now anybody listening to this that's read any MRI papers and understands a bit of MRI there's all sorts of studies showing that you imagine this

you imagine that. Most of those are group studies. If I take 16 people, put them in the scanner, get them all to imagine the face of the person they love, there will be some consistency in the activity that's produced. But that doesn't mean that every single person imagining a person they love is going to produce a statistically robust response. It's, you know, FMRI is a marvelous tool, but it's not as sensitive as we would really like it to be in single people. people. And obviously, I'm not interested in a group of patients whether on average they activate their brain when I ask them to think this or think that. I want to know whether this person, this single person in front of me right now will do it because it's all about this person. And it turns out there aren't

very many different things you can get people to imagine that will reliably produce activity in single. One of them is thinking about playing tennis. That works very well. The other one we use is to get people to think about walking through a familiar environment. So we'll say, you know, imagine you come home, you come through the front door, we want you to walk in real time to the washroom. And people are sort of mentally navigating a familiar environment. That will produce a very distinctive pattern of activity in an individual person that we can spot. And it's quite different than the pattern that we use to imagine playing tennis. So, you know, there's a yes and a no. Or yes, could be tennis, no, could be no tennis, could we discuss a bit further,

could be think about moving around your house. There are options. But once you get beyond two or three different tasks, two things happen. One is it becomes less reliable at the brain level. And the other is, people get really confused. If it's okay, it's yes for tennis, it's no for walking around my house, and it's maybe for, you know, imagining a picture of my loved one, it starts to get a little bit confusing, even for healthy people.

Kurt here, note that if you'd rather listen to Toe, we're on Spotify, iTunes, everywhere with a podcast catcher. You can just search my name or theories of everything. And also remember to hit subscribe. Can you imagine a brain computer interface that uses this technique that would be a much more coarse-grained version of something that Stephen Hawking had? Of course, he had much more control. And especially with time, you could let her a second or something like that.

Yeah, I absolutely can. I think that is probably the future. I mean, a project we're working on through an organisation called CFA. We have a program on brain-minded consciousness. And there, one of our sort of moonshots for the next 10 years is to see whether we can develop a brain computer interface that could be used for communication in a behaviorally non-responsive patient. You know, it's ethically tricky because we all know

that you're going to get much, much stronger signal if you could get through the scalp. So if you could use electrodes that are implanted in the brain rather than, you know, EEG on the outside of the brain or even FMRI, it's obvious that you would get much better signal by implanting the electrodes in the brain. But of course, that's invasive neurosurgery. And you're doing invasive neurosurgery on people

who arguably can't consent to it. Now, there are routes through this. And this is now me just sort of imagine, where one could go rather than stating where we're actually at. But one could imagine you could get consent from somebody using sort of tennis type of yes-no techniques in an fMRI scanner that could then lead you to doing something a little bit more invasive because you would actually have their permission for doing it. So there are steps that one can imagine to get there.

And I think you're right, or at least what you're. you implied is correct that brain computer interface will probably solve this problem. So the playing tennis is a proxy for the mind. And so do you think there can be a proxy for the proxy with skin conductance? Like imagine something, maybe this is the wrong thing to imagine, but imagine something fearful, then you'd sweat a bit more. Is that a route or is that connection also severed? It is. Now, we've tried that in one patient, actually. We tried to use galvanic skin responses to look for, yeah, different patterns of sweating that were related to sort of thinking different things. There are all sorts of things that you can imagine. I mean, it was suggested to

me once by a neurologist that you could get people to imagine sucking a lemon because that actually tends to, you know, induce a lot of saliva and things in your mouth. And, you know, if somebody's doing it, if you said to somebody, imagine sucking a lemon and the amount of saliva increased or the the acidity changed in their mouth. There's not really any other explanation that they are imagining sucking a lemon. But I think the reason why, you know, many of these techniques have some use

and they certainly work in some patients some of the time. But it's reliability, really. It's finding something that really does work in most people most of the time. That's what you need because, of course, you don't want to get it wrong. You know, the stakes are quite high with this patient group. So the bar that we set for, you know, decision making about whether somebody is conscious

or not is actually very high. We really, somebody is really displaying quite sophisticated levels of thought before we will conclude that they are aware. And I'm not saying that, you know, imagining being scared and sweating a bit, it doesn't involve high levels of thought. But certainly we found it to be a little bit less. reliable than the brain imaging. Right, right.

Now, can you imagine someone fails the tennis test and is still aware? Right. That's a really crucial question. And 100% I can imagine it. I mean, and we have to be extremely careful with these results. And I've written many times, we basically don't interpret negative findings. Right. If somebody doesn't imagine playing tennis, we don't say they're unaware.

We say the test was inconclusive. Now the reason for that is both practical and philosophical. On the practical side, I've already mentioned, what if you never played tennis? You have no idea what tennis is involved. If I say imagine playing tennis, you're not going to do it. It doesn't mean you're not aware. Likewise, if the patient was deaf or they couldn't understand spoken English,

we asked them to imagine playing tennis, it's not going to happen. It doesn't mean that they're not aware. The philosophical bit that I really think is interesting is, you know, at the end of the day, the very reason we're able to use this to get to somebody's awareness is because this is a conscious decision that we make. If I say to imagine playing tennis, you don't have to do it. when I'm giving public talks, I demonstrate this all the time by asking everybody in the room to raise their left arm into the air. And there'll always be somebody that doesn't do it. I don't think that person's not conscious. I think they're just maybe belligerent or, you know, can't be bothered to get involved.

Or, you know, there are all sorts of reasons. But it's a choice you make, right? It's not an automatic response to raise your hand when a speaker in a seminar tells you to raise your hand. It's something you say, okay, I'll go along with. this, I'm sure I'll find out why in a few moments. So same thing. I mean, it feels unlikely that the patient wouldn't do it if they could do it, but it's certainly a possibility, and that's another reason why we can't draw conclusions based on negative findings. Many people, this is like the difference between type 1 and type 2 errors, they find it more

consequential to make the mistake of labeling a conscious person as unconscious than they do to label an unconscious person is conscious. That's an interesting, that's an interesting idea. I would say they're equally important. I mean, if, you know, especially where decision making takes place in the ICU, I mean, if you were making a decision as has to be the case in most of these situations, about, you know, somebody that you loved or care about, about whether they should be withdrawn from life support or not,

I think that decision would change fundamentally if I told you, by the way, they're completely aware. I think your decision-making, now it doesn't, I don't mean to say you wouldn't do it, but I think your decision would be driven in part by that knowledge. And I think similarly, and this is the assumption that's most often made, if I would say to you what we do know is, if I could say this to you and I can't, but if I could say, what we do know is this person doesn't know who they are, they don't know where they are, and they don't know what's happened to them. I think, again, your decision-making might be a little bit different.

So I think they're both important for different reasons. My understanding is that Neil Seth had a paper or co-signed some paper saying that your test could also stretch to animals and even AI. Do you believe that? to detect consciousness and other non-human minds? Right. So Anil, yes, Anil says it could be extended to it. Well, that depends on exactly what test Anil was referring to. So, I mean, obviously, if I ask my pet dog to imagine playing tennis,

it isn't going to happen, right? And that's going back to the previous question. That's not because my dog has no consciousness or is not aware of anything. I don't know whether she is or she isn't. The fact that she can't play tennis doesn't inform that opinion. And that's pretty good. She obviously doesn't understand spoken language, at least doesn't understand the instruction to imagine playing tennis.

She's not going to do it. Similarly, with AI, what would it mean for an AI to imagine playing tennis? So I think that task probably doesn't easily lend itself to, for example, other species or AI. I mean, the question is, could variance of it do that? I mean, obviously, it doesn't have to be tennis. Are there instructions that you can do? And here, you just have to be a little bit careful because,

especially with other species, well, I suppose the same with AI, it's because, you know, you can teach all of these systems to do anything. You know, I can teach my dog to run to the bottom of the garden every time I yell the word run. That doesn't mean that when I put it in the scanner and I say, say run or when it just does it, it doesn't mean that it's got any necessarily any sort of conscious representation

of exactly what it's doing and why it's doing it. It's sort of learned behavior. So this is the interesting thing about tennis. We don't teach people to imagine playing tennis. It's something that they just do based on their knowledge of the world and representations they already have. And that's sort of quite different.

Anil may have been talking, and I think this has much more promise, about some of our more recent techniques that we've used. I mean, one of the problems with tennis is quite hard to do. I mean, it's quite cognitively demanding. I mean, we have people doing this for five minutes. You know, 30 seconds tennis, 30 seconds, rest, 30 seconds tennis. It's quite tiring.

It may not seem like it, but if you try it, you'll realize. So more recently, we've been coming up with other ways of establishing that somebody is conscious that doesn't require the same level of effort. And mainly it is through getting people to either watch movies or listen to a complex audio soundtrack. And it turns out that works just as well as tennis. And the idea is very simple. If I clap my hands, right?

Your auditory cortex and my auditory cortex both fired at exactly that moment, perfect synchrony, because both of our brains heard that sound and it activated. Well, when you watch a complex movie, the same thing is true of the rest of the brain. When a face appears on the screen, the areas of your brain that are involved in recognizing faces light up

and so do mine. Even when foreshadowing occurs and something happens that you know is going to be important in the future, your brain recognizes that at the same time that might recognize. The point is that if you put two people in a sense, scanner and have them watch exactly the same movie, two healthy people. Their brains become very tightly synchronized to one another. All the different areas light up at all the same time because we're having the same conscious experience. And I've often referred to this as, you know,

a good movie will hijack your consciousness. I imagine you're being in the movie theater watching a really engrossing movie. You forget you're there. You're not in the movie theater watching a movie. you're in the movie. It's, you know, it's your life right then. And that's in many ways the way I think about consciousness. Consciousness is being like being engrossed in this fantastic, ongoing movie. The sort of theoretical leap of faith is if I put a patient

who's behaviorally non-responsive is supposedly in the vegetative state into a scanner and all of the parts of the brain, not only the ulterior cortex, but the frontal lobes and the parietal lobes and the temporal lobes, all the different parts of the brain, they're involved in processing the narrative of the movie,

light up at the same time as a healthy person, what evidence is there that this person isn't having the same conscious experience that you and I are having? And we, you know, we've tested this in various ways. If we put somebody into a scanner and anesthetize them, we don't see this. If you put them to sleep in the scanner, we don't see this. You have to be awake and you have to be aware. But if you are both of those things, then your brain will respond pretty much like a healthy persons to something like a movie narrative. Now that, sorry, very long answer to your question, but that you can imagine applying to other scenarios.

I'm not going to stretch to AI, but certainly other species. One can imagine, you know, showing movies of sorts, obviously simple movies to apes, for example, and looking at the extent to which they are following the narrative of a movie. and deducing something about their conscious state based on that. So I think those types of tests are probably more broadly applicable than just adult humans. Yeah, I watched your talk where you were concrete and chose Taken, I believe, with Liam Neeson. We did use Taken a lot, yes. So why don't you give that example?

So why that movie, what is the theory of mind behind that? Yeah, that's a really great example. So Taken is the movie we use for the comatose patients. because they have eyes closed. And obviously, you know, showing them a movie, half of it is going to be lost on them because they can't see it. The great thing about anybody listening to this who's seen the movie taken with Liam Neeson will remember a particular scene when his daughter is going to be kidnapped,

and she's hiding under the bed in her apartment. And she calls her dad, Liam Neeson. and, you know, the conversation is, oh, yeah, the killers are in the apartment, they're going to get me, and they finally get her, and Liam Neeson says, put him on the phone, and he gets on the phone, and he basically says, I'm going to hunt you down, and I'm going to kill you.

It's a fantastic scene for movies. It's about five or six minutes long. It works beautifully without the visual. You don't need to see what's going on. You don't need to see Liam Neeson on the phone. You can just listen to his voice. It's fantastically evocative, and it's got everything that you would want.

It's engaging, it's, little bit scary. It's not terrifying, but it's certainly quite thrilling. It's tense. It's tense. And what we see is really high levels of synchronisation between individuals watching this, in that you know, you all realize at the same time that Liam Leeson, the next step is he's going to go out and hunt these people down. You can, you know, you realize that the girl is understandably terrified under the bed and all of these emotions and feelings and thoughts that fill in or color the, the narrative of the movie are there and we're all experiencing them at the same time. So that's been, yeah, that's been phenomenally useful for us and we've tried this in patients. In fact, we have a paper that just came out on Friday showing that the extent, in the ICU,

the level of similarity between a patient's brain listening to Taken and say your brain or my brain doesn't matter, will determine their likelihood of recovery. So the more similar they are, the more likely they are to recover. What's the largest misconception about your work? That it's easy, I think. I mean, somebody once said to me an elderly colleague,

something that stuck with me ever since he said this was after the 2006 science paper came out he said you know getting patients to imagine playing tennis anybody could have thought of that and I thought yeah but you didn't and we did and you know that sounds a bit arrogant

but I don't you know it didn't come out of nowhere it wasn't just a sort of oh let's come to motion know tennis it came out at that point I'd been doing brain imaging for 15 or 6 16 years. And I'm fortunate enough to be, you know, I was a very early adopter. I started imaging in right after FMRI was first developed in, in 92. So I had a lot of experience and that idea of, what would we need to do in order to be convinced that, you know, to produce a reliable brain activity and to be convinced that it's indicative of consciousness, it wasn't something that we just

sort of dreamt up one day. It was built on, you know, 10 to 15. years of really careful work. And, you know, a lot of money and an effort went into getting to that point. But I think people often just look at that and think, I just put something in a scanner. So, imagine playing tennis. That was easy. So I think, yeah, what we do is actually, it's actually pretty complex and logistically, you know, these people, especially the coma patients that we deal with, many of them are literally on death's door and moving them around to put them in scanners and keeping them alive at the same time. It's not an easy business.

And I think, you know, I see this in students that come into the lab. They're often surprised that, and how complex the whole operation really is. Well, the Liam Neeson test, that's not as obvious. It does sound obvious in hindsight, oh, imagine to play tennis or imagine to play something. But so does almost any physics idea that had fruition, math ideas as well. Yeah, I mean, the movie watching stuff came out. I mean, we first came up with that idea around about 2014. But again, it came from either other people working,

I mean, no one had applied that idea in non-responsive patients. But there were people looking at synchronization. There were many people before us had shown that two people, too healthy people watching the same movie, their brains will respond in exactly the same way. So the groundwork was sort of laid. I think the, there is a clever part about the whole thing. It was sort of realizing, so that's a, that's a method we could use in our particular

situation where we have non-responsive patients because, you know, you don't need the patient to respond. So, yeah, in some ways it's, yeah, it is more complex, but it was built on, you know, a lot of work that went before it. So for your research that just got published this Friday, do you have so much resolution in the data that you could say that if you pass the Liam Neeson test with this degree of wakefulness or activity or whatever you want to call it, that we can detect not only will you recover, but when you will recover with a certain probability, something like that. So that's what we're working on right now. I'm not going to tell you that the answer is yes. The answer is I think we can do that. But, you know, so we've made a huge amount of progress in the last few years using machine learning algorithms, the same as everybody else. But, you know, we're applying them in this particular situation where we take, we take all of the patients that we've seen, we take all of the clinical information that we know about them. We take their brain imaging data, what happens when they're watching Liam Neese, listening to Liam Neeson. We feed it all into a machine learning algorithm and we build models that try and predict who's going to recover.

That's basically the paper that came out on Friday. But it's not perfect. You know, it's about 80%. It can predict with about 80% likelihood whether you're going to recover or not. And, of course, there are many reasons why it's not perfect. One is, I'm sure there's more data we can feed into it. And this is where so-called multimodal imaging comes in.

And what about if we have Liam Leeson and we add the tennis data and we add a bit of EEG? You know, can we get close to a model? that can do what you're suggesting with 100% probability to tell whether somebody's going to respond. And, you know, can it get more nuanced like than that? Can we say how long it's going to say they're going to say them to respond? And, you know, I think the answer is probably eventually yes, but I think we're not there yet. If I recall correctly, you said that there's something, there's a thalamus deep within,

and then there's a frontal parietal, and the disconnect between them is what unifies the sum of these patients, that in us it's connected. And so our thought for the willful action is also followed by the action. Yeah. So if you think about the thalamus, it's right in the center of the brain. It's something like a relay station. And information goes from the thalamus up to your, you know, the cortex, the big thing that people are most familiar with about the brain. And there are two really quite distinct connections between the thalamus and the motor cortex. That's the part of your brain that actually allows you to move and makes the movements happen. And there's a different connection between the thalamus and the pre-motor cortex, which let's think of it as your

movement planning area, the area that sets up sequences of movements and says, okay, if you want to hit that tennis ball flying towards you at 120 kilometers an hour, this is what you're going to have to do. And it sets up, it sort of initiates those movements. And yes, what we showed, or one of my one of my former postdoc showed is that these patients that can sort of think but can't do have damage to their motor cortex but not damage to the premotor cortex. And that very neatly explains how you can end up in this strange situation where you can think an action but you can't actually carry that action out. It's one of these what we call projections from the thalamus is intact

and the other one is impaired. Two and five Canadians will hear the words, you have cancer. That's why every step and dollar raised matters. On September 19th, join thousands in Toronto for the Princess Margaret Cancer Foundation Walk. Challenge yourself, friends, and family to walk 21 kilometers in support of life-saving research. Together, we can carry the fire and help create a world free from the fear of cancer. Register today at pmcfwalk.ca. can we do something to accelerate the recovery? Your research is diagnosing potentially that the person has

consciousness. Well, in the cases that you can affirm, yes, they do have consciousness. They have awareness. But from that point, can you then do something to accelerate their recovery? So right now the answer is no, at least not in the long-term, you know, vegetative state patients. There really isn't anything available. Every so often somebody makes a claim about a new or an existing drug. and invariably the same thing happens, you know, it may have shown some effect in one patient and then they tried it in a clinical trial with a much larger group of patients and nothing much changes. So there is very little that, you know, that can be done in these long-term vegetative patients. That said, an area that we're looking at and other people I know are also looking at

is the idea of, you know, implanting electrodes. And I'm going to just, move into sort of science fiction now, but I think the nuts and bolts for doing this are in place. This is not really a fantasy, but there are a lot of practical issues that would need to be overcome. But, for example, could you map, you know, with so-called brain computer interface, could you map the pattern of activity that accompanies a patient when they're at their most lucid and then try and stimulate that same pattern when they're at their least lucid.

And that's an idea that we've been throwing around for a year or so now with people that use so-called deep brain stimulation, which is a treatment that's used very effectively for Parkinson's disease now, where you put a microelectrod into the brain, you stimulate a part of the brain and a case of Parkinson's disease, it can control some of the symptoms. Well, you know, there's reasons to believe you could extend that to trying to, if you like, sort of kickstart consciousness in some of these patients by stimulating the parts of the brain that are required for them to have some kind of subjective experience. You can see why I call it science fiction.

I mean, in practical terms, you know, you could practically do it tomorrow, whether it would work or not, I don't know. But, you know, there are a lot of sort of ethical and logistic hurdles to overcome. But there's not any reason why it couldn't be tried. I have a question, which is somewhat terrifying. So I'll put a trigger warning on screen. People can skip to the timestamp that we place on screen if you want to skip past this part. I heard, I don't know how much truth there is to this, that sometimes when you anesthetize patients, you put them out to do some invasive surgery,

that there are studies where if you ask them, are you feeling pain, they can raise their hand and say they felt the pain, something like that. Yeah. How true is that? Very true. I mean, it's very well known.

It's called anesthetic awareness. And I know, yeah, I mean, this is exactly relevant to, you know, what we've been talking about, because it's not just about patients, who are comatose or vegetative, we also don't have any way of knowing whether somebody who's having a general anesthetic to have their colon removed or whatever, we don't know, we don't have any good ways of knowing whether they're conscious or not either for exactly the same reason,

that the person stops behaving and we assume that they're unconscious and we know, you know, there are many cases of patients who've recovered from surgery and been able to report things that happened during the surgery that they can have only known if they'd had some level of awareness. And as you say, in some cases, patients have even, you know, been able to respond during the surgery. So, I mean, this is just another application of this technique, really, that I think I've mentioned already that, you know, we know that when you anesthetize somebody, there is a point at which you stop responding in any way to Liam Neeson's voice. and that's pretty good indicated to me that you are out and gone.

But of course, this is not what is routinely done in the operating room. Decisions about how much anaesthesia to give people are largely based on their medical history and their weight and these sorts of things and the fact that most of the time it works. But for very good reasons, anaesthesiologists try to give you as little aniseaer as they possibly can. So what they want to do is try and get you under, but just under. That's where they really want to be because these drugs are fairly dangerous. And if you have too much of them, it can cause complications. So an unfortunate side effect of that is that some people wake up or some people are partially aware during anaesthesia.

Now, is this mitigated now throughout time that it's getting better? somehow we know that we're actually putting them to sleep more and more? No. I would say, I mean, an anaesthesiologist will probably argue with me. I mean, I'm not suggesting that, you know, that in any sense, they don't know what they're doing, that they're extremely good at what they do and very, very careful. But in some ways, at least some of my colleagues have told me the situation is getting slightly worse because of this tendency to give people less anesthetic drug.

And also, there are other. the reasons that you recover more quickly if you have less anesthetic. You know, you make a speedy of recovery. You can go home the same day. There's less sort of side effects. And, you know, there's a lower possibility that you might die on operating table due to, you know, the effects of too much anesthetic drug. So, I mean, I think people, there's a move towards giving people as little anesthetic as they possibly can. And that's probably going to exacerbate. this situation. But are there new anaesthetic drugs being developed that are more effective that are able to keep you in that grey zone is the wrong phrase here. It's ambiguous, but you understand.

Well, it might be a good phrase, but yeah, there are. And things don't change a lot, but there are different, different sort of cocktails and combinations of drugs are now used to sort of optimize this situation. This is not something that happens very, very often. I probably should have said that at the beginning of this section. But it's certainly something that has happened and does get reported on. And I think this just underscores another reason why we need ways of measuring consciousness based on the brain that aren't simply dependent on behavior, because we know that people can stop behaving and still be conscious and aware.

And I think the word that we do has obvious implications. for anesthesia in otherwise healthy people. Okay, so trigger warning over, that section is fast. So you have a background in psychology or psychiatry, correct? Psychology was my first degree, yeah, and then I went into neuroscience for my PhD. Do you have any ideas to why there's a tie between anesthesia and psychosis, that sometimes anesthesia seems to increase your chances of psychosis or release latent psychosis, something like that?

Yeah, I don't. And these combinations are quite complicated. And I mean, we see the same thing, you know, in our patients. I mean, somewhat paradoxically, I think, one of the drugs that seem to improve some patients with vegetative state is something like Ambien or Zolpidem, which is actually a sedative. So I say paradoxically, because you. give them a sedative and they sort of somehow get slightly better. Now, you know, the research is, it's not absolute and not everybody agrees to the details.

But there's certainly reasonable evidence that some patients will benefit from this, but it's somewhat counterintuitive. And I know the same thing is, I think the same thing is true with the relationship between aspects of psychosis and drugs that I don't think we really understand. why the two things are connected, but often it's a discovery that's made accidentally. There's a movie with Robert De Niro and Robin Williams, I believe, called The Awakening's or Awakening's. And I remember a scene where someone threw a tennis ball at someone who was not responsive before and they catch it. Is this related to your work?

Yeah, it is because, I mean, that's a very good example of a fully automated system in your brain that you do not require consciousness for. in the sense that, you know, everybody's familiar with the example of, you know, putting your hand down on a hot plate and you were drawing it immediately before you've even had time to realize that the plate is hot. That's a reflex. And so is catching a ball that is thrown directly at your face. And, you know, a very sort of simple example of this is, you know, if the ball is thrown over there, those patients didn't run to catch the ball. They only responded, you know, when it was a third.

when it came directly at them and, you know, the brain has subconscious systems in place to deal with threats like a ball coming straight at you in the face. So, yeah, so our work is very related to that. And I don't think many vegetative patients would respond to a ball coming at them like that. But that's because their motoric damage is a little bit more extensive. But they certainly have reflexes often. and their simple reflexes often remain intact. And again, we don't, as in the Awakening's movie,

we don't assume that that means that they're conscious. We assume it means that those subconscious parts of the brain are still intact. Well, looks like they're conscious, but they're not. So we can have the behavior that seems conscious but isn't conscious. You can have behavior that's not conscious, but is indeed conscious. This whole podcast has been about that. Right. So then I'm sure you've listened.

maybe dipped your toll into the AI consciousness debate, where do you land? Where do I land on the AI consciousness debate? That was an interesting segue. Well, I don't really see any reason. I think it's a huge, to be honest, I think it's a huge storm teacup. I think we're asking completely the wrong question. I don't really know why this has suddenly become an issue. that we're starting to, you know, wonder about whether LLMs are conscious or not.

I find the whole thing quite surprising. I mean, the reason being that there are all sorts of other extremely sophisticated things in life that we don't have this feeling about. I mean, if I think back to my first car, like 30 years ago, you know, I had to wind the windows up. It had nothing resembling anything technical at all. The car I have now, you know, if I steer out of it, my lane, it steers me back into the lane, it can park itself. I tell it to dim the lights in the

car, it'll dim the lights. It does all sorts of things that are really quite sophisticated. I don't ever wonder whether it's conscious or not. It doesn't even cross my mind. And I think it's, I don't understand why, with things like that, we don't have these questions about consciousness, but with things like LLMs, we do. And I think it's probably the lure of language that as soon as something starts to behave like us, it's harder for us not to believe it's conscious. I mean, you know, and it's true in lots of other aspects of life too. When you look at, you know, a chimpanzee, you know, in the zoo,

and it waves and it laughs, it's really hard not to think it's got some, you know, conscious life, which it may well have. But we don't typically look at a cockroach and think the same thing. and it's not just because of the size of the animal, it's because a chimpanzee is more like us. It's doing things that are like us and we are conscious. And I think that's probably the line that AI, particularly through LLMs, has crossed.

It's crossed into the sphere of it being not possible for us to tell the difference between it. I mean, you know, I can't tell the difference if I'm talking to a chatbot on my phone provider, my cell phone provider, if I'm talking to a chatbot or a real person, I can't tell the difference. And so I think at the point that you can't tell the difference, it's just very hard to resist the temptation of assuming that this thing is like we are.

But I don't think there's any a prior reason to believe that any more than I should believe that my car is conscious. It's just doing really sophisticated stuff. And it's presenting it to me, at least in the L&N, situation in a human-like way. Something I like about you and your research is that even though I'm an abstract person and this channel is about math and physics and philosophy

and so on, you're extremely empirical. And you may save my life one day. Who knows? And you may save some of the people's lives who are listening or someone that they know. But do you have any philosophy of consciousness? Has any of this informed some other abstract views of yours? No. I think you're absolutely right. I'm an empiricist. And you know what? I'm going to stick with it because it's working much better for me than subscribing to any philosophy or theory, so-called theory of consciousness. I've just written a piece with a senior colleague of mine, which may or may not be published in the next few weeks, which basically makes the argument.

The theories of consciousness, well, our closing statement is that we've made enormous progress in understanding human consciousness in the last two decades. None of that is because of theories of consciousness. I stand by that. I think nothing I've done has been informed by a theory of consciousness. Absolutely nothing. What is, what, if I've achieved anything, it's been done by careful observation, measurement and working out what the sort of individual,

building blocks would be required for something to be the case. It's a very, as you say, empirical sort of scientific approach. None of this is grounded in any theory of consciousness at all. And I mean, you know, this is not something that everybody's going to agree with, but I just don't, I can't think of a single example where something we've learned about consciousness that we didn't know already was predicted by a theory which was then tested and shown to be true. So, again, this is, in some ways, this is the, the casualty of theories of consciousness in a way that it's very, or the casualty of consciousness, which is, it's really tempting or alluring to sort of come up with, like, folk notions of what we think consciousness

must be. But if you can't go out there and produce testable hypothesis that you, that you actually, you know, measure stuff, and show that, you know, this theory holds up or it doesn't, then it's not even a theory at all. It's just a folk psychological notion about what we think consciousness might be. Yeah, you don't have musings on consciousness. You actually get in the lab and help people come back into themselves, turn a thing into a person. I hope that's what we do. Yeah, I mean, that's what we try to do. And I think along the way, I don't want to, you know, undermine the sort of the broader science. I think along the way, that's a way.

taught us a lot about consciousness. It's not that it's just practical nuts and bolts clinical stuff. I'm a scientist. I'm not a, my, my, in a way, I didn't come into this, you know, in order to care for or about patients. I came into it to solve a problem, which is how can we, you know, get this person to express themselves when they're physically incapable of expressing themselves. And what do we know, what, what scientific tools can we throw at this to make this? to solve this problem. So, yeah, so no, I don't really sit around pondering theories of consciousness or what consciousness is.

I do sit around trying to work out, you know, whether some of our techniques are applicable to other questions about consciousness. There are some phrases in physics that are on the more empirical side that you hear them enough and they actually hold you back from making progress. and it's one of the reasons philosophers of physics will say, well, look, please, we can actually make progress and contribute to physics. Indeed, we have, and examples can be listed. So one example on the empirical side is shut up and calculate, and then the philosophers of physics will say, well, we came up with entanglement, we came up with weak measurements, and so on and so forth. It doesn't make a difference. The point is that also on the philosophical side of consciousness,

there's a statement that, well, you can't have a third-person view of something that's first person. So there is no science of consciousness. And it's said so often in the philosophy side that you just believe it. But then here, why I'm interested in speaking with you is you're like, what are you talking about? Yeah, I think I am because, you know, unless you've generated a hypothesis that we can go and test, it's just, yeah, it's what are you talking about? I mean, you know, what are you? This is just, it's very little. I mean, I mean, Think about the way, you know, real theories get generated and tested. And, you know, Darwin is probably the canonical example where, you know, for years before Darwin,

people just sort of sat around deciding how they thought everything worked based on what they saw around them. And, you know, it must be that giraffe have long necks because they're stretching to get into trees all the time. It seemed like really obvious, you know, but the fact is that. That's just completely not true. It's not only were they slightly wrong, it's that they were barking up, no pun intended, they were barking up the wrong tree.

And I think consciousness, you know, also, theories of consciousness also suffer from a lot of this, which is that, you know, words are thrown around like, you know, complexity or ignition or extinction, you know, words about, you know, how things come and go from consciousness. But unless you can actually measure that happening in the human brain and relate it to some actual aspect of conscious processing,

I think it's just hot air. Did you sign something about IIT saying that it's pseudoscience? I did. I did. And it wasn't, in some ways, the piece that I've just written with my senior colleague is a sort of an answer to that in the sense that, I think it was of a time that, you know, people, various sort of triggers occurred that meant IIT was the target there. But I think the same arguments can be leveled at many so-called theories of consciousness. I don't think IIT is particularly special.

It's, you know, it's a bit different. It's a bit more math-heavy than other things. And, you know, I did sign it because, you know, I do believe that it generates untrue. testable hypothesis and, you know, to be blunt, I don't think it's been terribly helpful in us understanding consciousness. It's been very helpful in allowing people to think about what they think consciousness might be, but until it actually yields something that tells us actual something measurable about consciousness that we didn't know already, I think it's just some group of people's ideas about what might be going on. So what are you working on that

can talk about. What's exciting you these days? Well, it's all very secret. It's very secret. No, I have a habit of talking about everything, regardless of whether it should be a secret. So what we're working on right now is really trying to maximize the likelihood that we can predict who's going to recover in the ICU. So we're working with coma patients. We see one or two a week, and we put them through the whole gamut. We have them doing EEG and fMRI and a new technique called functional near-infrared spectroscopy, trying lots of different things.

What we're trying to do is to improve the accuracy with which we can detect that somebody's aware when all evidence suggests otherwise. But more importantly, we're trying to predict who's likely to recover. And the reason for that is because, you know, if you have a very serious brain injury and people withdraw life support in the ICU, 70% of the time, sorry, 70% of the time, if you die in the ICU,

it's going to be because a decision was made to withdraw life support. People don't typically die of natural causes these days. They more often die because decisions made that they're unlikely to recover, they're unlikely to have any quality of life. They don't know who they are and where they are in the predicament they're in. it may be best to sort of let them go. I'm not saying that's wrong, but it's certainly not all of the information for all the people. And some of those people may have a better chance of survival than others. And if we can identify who those people are, maybe we can give them a little bit more time.

Maybe we can direct the limited resources that we all have available to us towards those patients who are most likely to recover. So I'm really working on different methods of maximizing survival after serious brain injury in the ICU. Professor, thank you for spending so much time with me in the audience. It's an absolute pleasure.

Thanks for your great questions. Okay. Wait, sir, don't you have another book coming up? I do. Funny enough, this book is coming out on the 4th of August.

Think Before You Think, which is a sort of very much a follow-up to Grey Zone. I talk about some of the patients that I met to write the Grey Zone book and what's happened to them since, but also it deals with the relationship between consciousness and, for example, conditions like Alzheimer's disease,

where, you know, arguably you have changes in the way people consciously perceive the world and how that affects their personality and the relationships with people around them. So, yeah, think before you think. Next week, sometime. All right. Well, links to all of what has been mentioned, whether it's research papers, whether it's books. We'll all be on screen and in the description. Thank you. Take care. Wonderful. You too. I like your sort of mix of a bit of philosophy and a bit of theorizing and some physics and obviously some neuroscience. So I enjoyed it. Hi there. Kurt here. If you'd like more content from theories of everything and the very best listening experience, then be sure to check out my substack at kurtjymongle.org.

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